Pre-Marriage Counselling in Nagpur
A medical consultation for a couple before marriage or before a first pregnancy. Blood group and Rh, carrier screening for thalassaemia and sickle cell, immunity and vaccination, and a gynaecological assessment — with a doctor whose subspecialty is genetic and fetal medicine.
What this consultation is
Pre-marriage counselling here is a medical consultation for a couple, not a checklist of tests sold as a package. It covers the things that change what happens to your health and to your children: whether either of you carries a gene for thalassaemia or sickle cell disease, blood group and Rh, immunity and vaccination before a first pregnancy, and any gynaecological condition that is easier to sort out now than later.
Most premarital testing in India has narrowed down to a familiar set: blood group, HIV, hepatitis, a scan. Those are worth doing. But the part that most often gets left out is the part that actually determines whether a couple has a child with a serious lifelong condition, and it is not expensive, not complicated, and not routinely offered.
Dr. Kunda Shahane is an obstetrician-gynaecologist whose subspecialty is fetal medicine and prenatal genetics. Deciding which genetic test is indicated, interpreting it, and explaining what it means for a couple is the substance of her working week rather than an add-on to a general consultation. That is the difference between a premarital test panel and a premarital consultation.
Which page do you need?
Testing for an infection
HIV, hepatitis B or a sexually transmitted infection, whether before marriage or at any other time. Testing, treatment and partner treatment are covered separately.
Worries about sex itself
Pain, difficulty with penetration, anxiety about the first time, or questions you have not been able to ask anyone. Assessed as a medical problem, not a personal failing.
Already trying to conceive
If you are married and have been trying for some time, this is a fertility evaluation rather than a premarital consultation, and it starts in a different place.
The part that gets left out: carrier screening
Thalassaemia and sickle cell disease are inherited recessively. That means a person can carry the gene, be completely healthy, have no symptoms, no family history they know of, and no reason ever to be tested — and still pass it on. A carrier is not ill and does not become ill. The consequence appears only when two carriers have children together.
The numbers are not small. Around 3 to 4 per cent of the Indian population carries the beta-thalassaemia trait, rising to 8 to 10 per cent or higher in some communities, and between 10,000 and 15,000 babies with thalassaemia major are born in India every year. For sickle cell, the carrier frequency in affected communities ranges from 1 to 35 per cent.
And this is a Vidarbha question specifically. The sickle cell gene is widespread across the eastern districts of Maharashtra. The National Sickle Cell Anaemia Elimination Mission, launched in July 2023 with the aim of eliminating the disease as a public health problem by 2047, covers 21 districts in this state — Nagpur, Wardha, Chandrapur, Bhandara, Gondia, Gadchiroli, Yavatmal and Amravati among them. That is not a national statistic happening somewhere else. It is the catchment this clinic sees.
What being a carrier does and does not mean
Only one of you is a carrier
No child of yours can have the disease from this gene. Some children may be carriers themselves, exactly as one of you is, which matters for them when they marry rather than for you now. This is the commonest result and it needs an explanation, not a reassurance.
Both of you are carriers
For each pregnancy there is a one in four chance of an affected child, a two in four chance of a carrier, and a one in four chance of a child who carries nothing. Those odds apply to every pregnancy independently — a healthy first child does not change them for the second.
What happens then: genetic counselling before you conceive rather than after, confirmation of which mutation is involved, and a pregnancy planned from the beginning with early testing arranged and specialist care in place. Knowing in advance is the entire point of testing in advance.
You are related to each other
Marriage between cousins is customary in several communities and is not being questioned here. It does raise the chance that both partners carry the same recessive gene, inherited from a shared ancestor, and that is a reason to screen more carefully rather than a reason for alarm. The screening is the same; the threshold for doing it is lower.
Being a carrier is not a reason not to marry
This needs saying plainly, because carrier results are sometimes treated in families as a verdict on a match. Two carriers can marry and can have healthy children. What changes is that the pregnancy is planned and monitored instead of being left to chance. A result that is used to break an engagement has been misunderstood.
Blood group, Rh, and a myth worth correcting
Blood groups are checked at almost every premarital screening in the country, and the reason is very often misunderstood. Couples are told their groups are incompatible, and take it as a warning about the marriage. It is not one.
What actually matters is this: if the woman is Rh-negative and her partner is Rh-positive, the baby may be Rh-positive. If the mother's blood is exposed to the baby's, she can form antibodies against it. Those antibodies rarely affect a first pregnancy, but they can seriously affect the next one and every one after it. The whole problem is preventable, and it is prevented with anti-D given at the right moments — after certain events in pregnancy, and after delivery.
So an Rh-negative woman marrying an Rh-positive man is not a medical problem. Missing the anti-D is the medical problem. Knowing before marriage means it is in the notes from the first day of the first pregnancy, which is when it is easiest to get right. Managing Rh-negative pregnancy and antibody surveillance is part of Dr. Kunda's practice, so this is not a fact she is passing along; it is one she acts on.
At a glance
- Who it is for
- Couples before marriage, or before a first pregnancy
- Seen by
- Dr. Kunda Shahane, obstetrician-gynaecologist and fetal medicine specialist
- Together or apart
- Either — you decide
- When
- Ideally two to three months before the wedding
- Core screening
- Blood count and red cell indices, thalassaemia and sickle cell carrier status, blood group and Rh
- Samples
- Taken at the clinic, processed at an external laboratory
- Ultrasound
- At the clinic, where the history indicates it
- Results
- Explained in person, not handed over as a printout
- Privacy
- Each person’s results belong to that person
Immunity and vaccination before a first pregnancy
Rubella is a mild illness in an adult and a serious one in early pregnancy, where it can affect the baby's hearing, sight, heart and brain. Immunity is checked with a blood test. Where a woman is not immune, vaccination is arranged before conception rather than during pregnancy — the vaccine is a live one and is not given to a woman who is pregnant. The recommended interval is 28 days between the vaccine and trying to conceive, shortened from three months by the Advisory Committee on Immunization Practices in 2001.
Two other things belong in the same conversation. Hepatitis B status is checked, because it can be transmitted to a partner and to a baby at delivery, and because both are preventable. And HPV vaccination is worth discussing before marriage rather than after, since it gives the most protection when given before exposure — a point most couples have never had put to them.
Folic acid is started before conception, not when the pregnancy test turns positive, because the part of the baby it protects is formed in the first few weeks — often before a woman knows she is pregnant. The dose is not the same for everyone; it is higher where there has been a previous baby with a neural tube defect, in diabetes, and with certain medicines. That is decided in consultation, which is why no dose is printed on this page.
What happens at the consultation
- How you want to be seenCouples are seen together where both want that. Either of you can also be seen alone, and it is normal to want part of the conversation private. That is arranged without anybody having to justify it.
- History from both of youFamily history in particular — anyone in either family with thalassaemia, sickle cell disease, repeated blood transfusions, an inherited condition, a child who died young, or a known genetic diagnosis. Whether you are related to each other. Menstrual history, previous illness, current medicines, and vaccination history.
- Examination where it is indicatedA gynaecological examination is not automatic and is not done without consent. Where periods are irregular, painful or absent, or where the history points to a condition worth identifying now, examination and a pelvic ultrasound at the clinic answer it.
- Tests chosen for the two of youA blood count with red cell indices and haemoglobin electrophoresis or HPLC for carrier status; blood group and Rh; rubella immunity; thyroid function; and infection screening where it is wanted. Not a fixed panel — what you need depends on your history and your family history. Samples are sent to a laboratory; there is no laboratory on the premises.
- Results explained together, or separatelyWhat each result means, and specifically what it means in combination with your partner's, which is where carrier screening either matters or does not. A borderline result is investigated further rather than reported as normal.
- A plan, not a certificateWhat to do before conceiving, what to treat now, what vaccination is needed and when, and — if you are not planning a pregnancy immediately — what contraception suits you in the meantime.
Worth doing
- Come two to three months before the wedding — laboratory results take time and some need a second step
- Ask both sets of parents about family illness before you come; most people find something they did not know
- Bring any old reports, however unrelated they seem
- Say if you and your partner are related, however distantly
- Bring your vaccination record if you have one
- Come even if only one of you can attend — a start is better than waiting for a joint appointment that keeps not happening
Worth avoiding
- Buying a premarital package online without knowing which tests are in it or why
- Treating a carrier result as a verdict on the marriage
- Assuming that no family history means no carrier risk — most carriers have no family history
- Testing only the woman; carrier screening is meaningless unless both are tested
- Leaving the blood tests until the fortnight before the wedding
- Sharing a partner’s result with relatives without asking that partner first
Whose results are they?
This comes up in almost every one of these consultations, and it is worth settling at the start. Each person’s results belong to that person. Where a couple is seen together and both agree, they are gone through together, which is usually what everybody wants — carrier screening only means something when both results are read side by side. But nothing about one partner is disclosed to the other, or to a family member, without that person’s agreement.
If there is something you want to discuss on your own, ask for a few minutes alone. It is a routine request in this clinic and it does not need a reason.
Why this is a fetal medicine consultation, not a test list
A laboratory can report that both of you carry a thalassaemia gene. It cannot tell you which mutation, what that combination is likely to mean, what testing is available in a pregnancy and when in the pregnancy it is done, or what care that pregnancy would need from the first weeks. That is genetic counselling, and it is a different skill from ordering the test.
Here the same doctor takes the history, chooses the tests, interprets them, counsels the couple, and — if a pregnancy follows — performs the scans, arranges any prenatal diagnosis that is indicated, and manages the pregnancy. Nothing is handed between people, and no couple is left holding a report that nobody has explained.
What it costs
There is no premarital package here, deliberately. Packages are priced to be sold rather than to fit a couple, and they routinely include tests nobody needs while leaving out carrier screening, which is the one that matters most.
| Item | How it is charged |
|---|---|
| Consultation for the couple | Charged as a gynaecology consultation |
| Blood tests, including carrier screening | Billed by the laboratory that processes them, according to which tests are ordered |
| Pelvic ultrasound | Charged separately, only where indicated |
| Vaccination | Charged per vaccine |
| Follow-up to discuss results | Charged as a follow-up consultation |
WhatsApp +91 8087471244 with your wedding date and whether either family has a history of thalassaemia or sickle cell disease, and you will be told what the consultation costs and roughly what the tests will come to.
What this consultation is not
It is not a compatibility certificate. There is no test that reports whether two people are suited to each other, and any screening presented that way is being oversold.
It is not a fertility prediction either. Tests of ovarian reserve have a place in specific situations, but as a routine item on a premarital panel they mislead more couples than they help — a number on a report says far less about whether you will conceive than most people are told. Whether you need one is decided after the history, not before it.
And it is not relationship counselling. Communication, expectations and the emotional side of marriage matter, but they are the work of a counsellor rather than a gynaecologist, and a doctor claiming both is claiming too much. What is offered here is the medical half, done properly.
Questions women ask
When should we come for pre-marriage counselling?
Ideally two to three months before the wedding. Blood tests take time to come back, carrier screening sometimes needs a second confirmatory step, and if vaccination is needed there is a required interval before conceiving. Coming a fortnight before the wedding still helps, but it removes the option of doing anything about what is found.
What tests are done before marriage?
The core set is a blood count with red cell indices, thalassaemia and sickle cell carrier testing by haemoglobin electrophoresis or HPLC, blood group and Rh typing, rubella immunity, and thyroid function. Infection screening is included where it is wanted. A pelvic ultrasound is added where the history indicates it. This is decided from your history and your family history rather than ordered as a fixed package.
What is a carrier, and can a carrier become ill?
A carrier has one copy of the gene and one normal copy. Carriers are healthy, do not develop the disease, and usually have no idea they are carriers because there is nothing to notice. Around 3 to 4 per cent of people in India carry the beta-thalassaemia trait, and in some communities it is 8 to 10 per cent or more. It matters only when two carriers have a child together.
Both of us are carriers. What happens now?
You are seen for genetic counselling before you conceive rather than after. The specific mutation is confirmed, you are told exactly what the chances are for each pregnancy — one in four affected, two in four carriers, one in four neither — and a future pregnancy is planned from the beginning, with testing arranged early and specialist care in place from the first weeks. That planning is the reason for testing before marriage rather than during a pregnancy.
Does being a carrier mean we should not marry?
No. Two carriers can marry and can have healthy children, and a carrier result is not a verdict on a match. What changes is that a future pregnancy is planned and monitored rather than left to chance. Where a family is treating a report as grounds to break an engagement, the result has been misunderstood and it is worth sitting down and going through it properly.
Nobody in our families has thalassaemia. Do we still need testing?
Yes, and this is the single most common misunderstanding about it. Most carriers have no family history at all, because carriers are healthy and nothing has ever drawn attention to it. A family only finds out when an affected child is born, and at that point the information has arrived too late to be useful. That is exactly what screening before marriage prevents.
Why does sickle cell matter particularly in Nagpur?
Because the sickle cell gene is widespread through the eastern districts of Maharashtra. The National Sickle Cell Anaemia Elimination Mission covers 21 districts in this state, including Nagpur, Wardha, Chandrapur, Bhandara, Gondia, Gadchiroli, Yavatmal and Amravati, with the aim of eliminating the disease as a public health problem by 2047. Carrier frequency in affected communities has been reported anywhere from 1 to 35 per cent. For couples from this region it is not a distant concern.
My blood group is negative and my partner's is positive. Is that a problem for the marriage?
No, and this is worth correcting because it frightens a lot of couples unnecessarily. An Rh-negative woman with an Rh-positive partner may carry an Rh-positive baby, and if her blood is exposed to the baby's she can form antibodies that affect later pregnancies. It is preventable with anti-D given at the correct times during and after pregnancy. Knowing your Rh status before marriage means it is in the record from the very first antenatal visit, which is when it is easiest to manage.
We are cousins. Should we do anything different?
Marriage between relatives is customary in several communities and is not in question here. It does raise the chance that both of you carry the same recessive gene inherited from a shared ancestor, so the threshold for carrier screening and for a careful family history is lower. The tests are the same ones; the reason for doing them is stronger.
Can we be seen separately rather than as a couple?
Yes. Couples are seen together where both want that, and separately where either of you prefers it, including for part of the consultation only. Each person's results belong to that person and are not disclosed to a partner or a family member without their agreement. Asking for a few minutes alone is a routine request here.
Does this include testing for HIV and other infections?
It can, and it is commonly wanted before marriage. Testing, treatment and partner treatment for sexually transmitted infection are covered in more detail on the STD and STI testing page, which explains which tests are meaningful at which point after an exposure. If that is your main concern, start there instead.
Is this the same as marriage counselling?
No. Communication, expectations and the emotional side of a marriage are real and important, and they are the work of a trained counsellor. What is offered here is the medical part: carrier screening, blood group and Rh, immunity and vaccination, gynaecological assessment, contraception if you are not planning a pregnancy immediately, and genetic counselling where it is needed. Anyone offering both in one appointment is stretching.
During premarital counseling, couples are often surprised when we discuss genetic conditions like Thalassemia. I strongly believe that premarital checks should go far beyond just matching blood groups. For the sake of future family planning and sexual health, I truly wish more couples would come in for these consultations.Dr. Kunda Shahane MBBS · MS (Obs & Gynae) · FIFM · FMF (London)
- Ministry of Health and Family Welfare, Government of India. Guidelines on Hemoglobinopathies in India — approximately 10,000–15,000 babies with thalassaemia major born each year, and a sickle cell carrier frequency ranging from 1 to 35% in affected communities of central India, Maharashtra, Gujarat and Kerala.
- National Health Mission. National Sickle Cell Anaemia Elimination Mission — launched 1 July 2023, covering 278 districts across 17 states including Maharashtra, with the aim of eliminating sickle cell disease as a public health problem by 2047.
- Public Health Department, Government of Maharashtra. Sickle cell screening programme — mass screening across 21 Maharashtra districts including Nagpur, Wardha, Chandrapur, Bhandara, Gondia, Gadchiroli, Yavatmal and Amravati.
- Gorakshakar AC, Colah RB. Cascade screening for β-thalassemia: a practical approach for identifying and counseling carriers in India. Indian J Community Med 2009;34(4):354–356 — overall carrier prevalence of 3–4%, rising to 8–10% or more in some communities.
- Advisory Committee on Immunization Practices. Revised recommendation for avoiding pregnancy after receiving a rubella-containing vaccine. MMWR 2001;50(49):1117 — the interval was shortened from three months to 28 days.
Written and medically reviewed by Dr. Kunda Shahane, MBBS · MS (Obs & Gynae) · FIFM · FMF (London) · Last reviewed: 6 September 2026
Related pages
Come as a couple, or come on your own first
Book a pre-marriage consultation with Dr. Kunda Shahane. Couples are seen together where both want that, and separately where either of you would prefer it. Allow time for the blood tests, ideally two to three months before the wedding.
Mayflower Clinic, Surdham Complex, Behind Silver Palace Building, 2nd Lane from Panchsheel Square, Opp. Yashwant Stadium, Dhantoli, Nagpur – 440012 · Monday–Saturday, 10:00 AM – 6:00 PM · Sunday closed
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